Audio-only telehealth continues to be used more frequently than video visits in safety net clinics, according to a study by RAND Corp. researchers. The study examined the evolution of telehealth in federally qualified health centers in California from February 2019 to August 2022. While the use of audio-only telehealth declined during this period, researchers noted that its continued use was likely due to the lack of access to technology for video-based telehealth. Further studies are needed to determine the effectiveness of audio-only telehealth in safety net settings.
The COVID-19 pandemic brought about a surge in telehealth utilization due to restrictions on in-person care, increased reimbursement from payers, and concerns about virus transmission. In the early stages of the pandemic, both audio-only and video-based telemedicine were extremely popular. However, questions have been raised regarding the effectiveness of audio-only telehealth in treating low-income patients in safety net settings. To gain insights into this issue, researchers from RAND Corp. conducted a study on the evolution of telehealth in federally qualified health centers (FQHCs) in California.
The study, published in the Journal of the American Medical Association, found that audio-only telehealth continued to be used at higher rates than video visits in safety net clinics in California. Researchers analyzed data from 30 multisite FQHCs in California, covering the period from February 2019 to August 2022. They found that between February 2020 and August 2022, primary care visits increased by 8.5%, while behavioral visits increased by 23% across the FQHCs. Audio-only telehealth for primary care was at its highest in April 2020, while its usage for behavioral health peaked in March 2021.
The share of in-person visits for primary care was 30% in April 2020, increasing to 71% in August 2022. Audio-only telehealth dropped from 67% to 21%, while video visits rose from 4% to 7% for primary care. In-person visits for behavioral health rose from 20% to 37% between April 2020 and August 2022. Audio-only service use declined from 74% to 39%, and video visits rose from 8% to 23%.
Researchers noted that the use of audio-only telehealth for both primary care and behavioral health dropped between 2020 and 2022. However, its continued usage is likely due to clinics not having access to the technology needed for video-based telehealth. The Medicaid Program of California (Medi-Cal) provided permanent payment parity for this type of telehealth, indicating that there are no financial incentives associated with eliminating audio-only telehealth. Therefore, audio-only telehealth remains in use, and further studies are needed to determine its efficacy in safety net settings.
In August 2022, a study found that audio-only telehealth provided benefits comparable to video-based telehealth when treating underserved patients. The study involved a clinical trial in which patients participated in a clinic visit via phone or video-based telehealth. Researchers used satisfaction rate as the main unit of measurement and found that although there was a slight difference in satisfaction levels between the two modalities, satisfaction rates did not exceed the margin needed to establish inferiority.